At Mount Sinai Beth Israel, the Division of Plastic Surgery works closely
with world-class cancer surgeons in various specialties to offer our patients
top-quality reconstructive surgery following treatment for cancer. Reconstructive
surgery is frequently an essential part of cancer treatment and is often
performed to improve both function and appearance.
Our reconstructive surgeons work closely with cancer surgeons in developing
a plan of care, and our acclaimed microsurgery program serves the broad
reconstructive needs of the Continuum Cancer
Centers of New York. The Division’s skill in microsurgical free
tissue transfer is routinely employed in complex areas of reconstruction,
including head and neck reconstruction and breast reconstruction.

Breast Reconstruction
Advances in breast reconstruction techniques have dramatically improved
the options for breast
cancer treatment. At Beth Israel, our renowned reconstructive plastic
surgeons are involved with breast cancer cases from the beginning, working
as a member of the team that evaluates the oncologic and reconstructive
options of breast cancer patients and develops a strategy that is most
appropriate for that individual.

Most mastectomy patients are appropriate candidates for breast reconstruction.
Of course, the decision is a highly personal one, to be reached by the
woman, her family, and her medical team. A patient can start talking about
reconstruction with her physician as soon as she receives her cancer diagnosis.

While breast reconstruction doesn’t need to be done immediately
following surgery, there are several benefits to performing immediate
reconstruction— the patient will have to face just one operation,
one hospitalization, and one recuperation. Plus, there are certain procedures
that allow for a better reconstruction that plastic surgeons can perform
only at the time of a mastectomy. Perhaps most importantly, studies have
shown that immediate reconstruction helps women get through this traumatic
time more easily. There are also reasons to wait, however. If you aren’t
comfortable with making the decision right away, you don’t want
more surgery, or if the reconstruction calls for a more complicated procedure,
then you may want to postpone reconstruction.

The next decision the woman and her physician must make is what kind
of reconstruction to have—implants, or autogeneous, which uses her
own tissue. An autogeneous reconstruction offers a single operation and
a more natural result, while implant reconstruction requires two smaller
procedures. For the implant method, the surgeon will typically insert
a balloon expander under the skin and chest muscle after a mastectomy.
Then over a period of several weeks, a salt-water solution will be added
to gradually fill this expander and stretch the skin. After the expander
is removed, a breast implant is inserted. Occasionally, if there is no
need for tissue expansion, the surgeon can simply insert an implant following
the mastectomy.

If a patient desires a single stage breast mound reconstruction, but lacks
enough autogenous tissue to create a full breast, muscle and skin from
the back can be rotated around to the breast region to cover the implant
in one operation. This makes tissue expansion unnecessary and therefore
saves the patient the extra operation to remove the expander and place
the implant. The muscle and skin from the back also provide a softer,
more natural reconstruction since the tissues are not stretched over the
impant like the expanded tissues.

Breast implants can be filled with either silicone gel or a salt-water
solution known as saline. However, due to concerns that there isn’t
enough information demonstrating the safety of silicone implants, the
Food & Drug Administration has ruled that silicone gel-filled implants
can only be available through approved studies. Beth Israel is participating
in one such study—the McGhan
Medical Corporation Silicone Breast Implant Trial.

For autogeneous reconstruction, a flap is created from skin, fat, and
muscle from other areas of the body, such as the abdomen. Sometimes the
surgeon leaves the tissue attached to its original site, and tunnels the
flap beneath the skin to the chest. This can create the breast mound or
a pocket for an implant. Beth Israel’s plastic surgeons also specialize
in the free tissue flap technique, in which the surgeon takes skin and
fat from another part of the body, transplants it to the chest, and reconnects
its blood vessels to ones in the chest or armpit. This operation requires
a skilled microvascular surgeon. Both types of flap reconstruction are
more complex than skin expansion, but generally create a more natural
result.

Head and Neck Reconstruction

Head and neck cancer refers to a wide range of cancers that affect a
variety of locations, including the face, eyes, ears, nose, lips, jaw,
throat, tongue, cheek and more. Because of their location, these cancers
can cause defects that are both functional and cosmetic, and the patients’
reconstructive needs can present the surgeon with numerous challenges.
The complex anatomy of this area means that functions such as speech,
swallowing and airway protection can be affected. At Beth Israel, our
reconstructive surgeons’ goal is to minimize loss of function while
maintaining as normal an appearance as possible.

At one time, reconstruction could only fill the defect, and the cure for
head and neck cancers was sometimes considered worse than the disease.
However, refinements in microsurgical and craniofacial techniques now
enable the plastic surgeon to perform reconstruction on patients with
even the most advanced type of tumors. Frequently, the plastic surgeon
works in conjunction with a surgical oncologist. With microsurgical techniques,
the plastic surgeon can repair large and severe defects, allowing the
cancer surgeon to be even more aggressive in the resection of the tumor.

At Beth Israel, plastic surgeons specializing in head and neck reconstruction
work closely with head and neck surgeons and radiation oncologists at
the Continuum Cancer Centers of New York
to develop surgical treatment plans. Our dedication to state-of-the-art
reconstructive care can be seen in our formation of an integrated Medical,
Extirpative, and Reconstructive Head and Neck Cancer Institute.

Skin Cancer and Reconstruction

Since about 80 percent of skin cancers appear on highly visible areas
of the face, head, or neck, they can be extremely disfiguring. That’s
why the skills of a highly qualified plastic surgeon are essential. At
Beth Israel’s Division of Plastic Surgery, our plastic surgeons
specialize in removing malignant and benign skin growths in a way that
both removes the cancer and maintains function and as normal a cosmetic
appearance as possible.

The type of procedure required and the cosmetic results depend on the
size and severity of the skin cancer. For small cancers, the surgery may
be a simple and quick excision with a scalpel that leaves a barely noticeable
scar. For larger cancers, surgeons may use curettage and desiccation—scraping
out the cancer with an electric current that controls bleeding and destroys
the remaining cancer cells—which may leave a larger, white scar.
More severe cancers can result in permanent changes in structures such
as the nose, lip, or ear. It may be necessary to use skin flaps taken
from other areas of the body reconstruct the affected area.

While our plastic surgeons are highly qualified to diagnose and treat
skin cancers, they can also be involved if you use a dermatologist for
your initial treatment. Using reconstructive techniques that range from
simple scar revision to complex tissue flaps, our plastic surgery team
can repair the damaged tissue and restore function and a more pleasing
appearance to skin cancer patients.